Name of Applicant: _________________________________________________________
Address: _________________________________________________________________
________________________________________________________________________
Phone Number: ________________________

Name of Organization: _______________________________________________________
Address of Organization: _____________________________________________________
Purpose of meeting: _________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Date of meeting: ________________________________________________________________
Time of meeting: ________________________________________________________________
Number of people expected: ________________

Room requirements:
Tables ____________ Chairs ____________ Equipment ___________________

I have read the Raynham Public Library Meeting Room Policy, and I agree to abide
by its guidelines and to be responsible for damages to the library equipment, furniture
and/or facilities during my scheduled use of the room.
I agree to pay the $25.00 fee for use of the room upon or before my scheduled use of the room.

Signed: _________________________________________________________________

Date: ___________________________________________________________________

Received and scheduled by Library Staff member: ________________________________
Approved by Library Director: _______________________________________________
Date: ________________________________

 Approved Board of Library Trustees March 2003